Tests normal, yet possible angina?

[potatolover]

Hello,  27 year old male here. Non-smoker. I eat as best I can with no trans-fats, lower saturated fat, only whole grains and lots of whole foods with increased fiber intake. Over the summer I lost 40ish pounds (down from 180 to 140) but I live a somewhat sedentary lifestyle (I'm working on changing that). I was running 3-5 miles several times a week last summer (a year before the diet change) but stopped last winter.

Back in August I had a bunch of heart tests done because I had been complaining of chest pain. My dad had an MI when he was 25 and I have a VERY strong paternal family history of heart disease. So I had to have things checked out just to make sure.

EKG came back fine.

I had a treadmill nuclear stress test that came back showing no signs of ischemia or blockages

I had an echocardiogram that showed I have mild mitral valve prolapse

I also had a bunch of blood work done and my cholesterol came back with HDL: 67 and LDL: 129

I've also been wearing a 30 day heart monitor to monitor any cardiac events. So far everything is normal.

Yet I still have this nagging feeling. New symptoms have cropped up. Sometimes when I exert myself I'll feel chest tightness in the left center of my chest. Usually no other symptoms. It goes away when I chill. I can't tell you whether or not it's angina but occasionally it shows up when I'm chilling out. Sometimes I'll wake up to a racing heart (I suffer from anxiety) that the chest tightness will accompany more often than not. Again, I'm not sure if it is actually angina. Maybe it is coincidental? It went away for several days but then when I took a brisk walk it came back (HR was around 112).

Is there a possibility that things have changed so drastically that I could have developed plaque or my cholesterol has changed? I have a strong predisposition to high cholesterol, so is it plausible despite my diet that I was on for months before the initial tests? Should I go back and get tested again even though it was around 4 months ago?

Or is it most likely something else entirely and I should just chill out?

Telling myself that my cholesterol is mostly okay has helped my anxiety yet the chest pain returned today.

Apologies if the post was all over the place. I'm just looking for answers.

[Al Dente]

Given family history, it is possible and plausible that you have a cardiovascular issue.  You need to discuss the results with your physician.    Firstly background as to why...  I was diagnosed with 3 vessel coronary artery disease at 26 and had my first stent for a 75% block in my right coronary artery.  Bad heart genetics on both side of my family.  I have a genetic lipid disorder.  Testing the type(s) and concentrations of lipids can help shed some  light if you possibly have an aggressive lipid disorder.

An echo will yield little unless there is a clear problem--and even then it is up to the skill of the interpreter.  However the test is valuable, and does set a baseline.  EKGs are not definitive especially in diagnosing ischemia.  A standard stress that is not a nuke stress adds little value for diagnosing young people as often times the workout is harder than the stress.

As ed34, coronary spasm could be blame.  Vagus nerve malefaction as ed34 describes can play havoc on the heart.  At sites of larger lesions if one has one, the site (one of the coronary arteries) could spasm.  The only clear diagnostic for this issue is cardiac catheterization.  I had chest pain early on in my life, along with hearth rhythm issues and frankly had an extremely difficult time with diagnosis having symptoms, severe family history, and worsening issue.  Since that time of diagnosis about 13 years ago of 3 vessel moderate CAD, I've had 5 stents placed, on my second dual chamber pacemaker, 2 MI's and am now in heart failure (left ventricular diastolic dysfunction, combined systolic and diastolic heart failure .  I was diagnosed with heart failure in 2013.  

It is possible for young patients to have heart disease at a young age.  As well, you can have valve pain.  ER docs may say if you feel a sharp pain, or tearing pain, it isn't cardiac.  Not true.  Family history plays a huge rule.  A younger patient's angina will differ from an older person.  It's possible to have a heart attack and just fell tired--it may not be the full-on heart attack that's described as an obvious heart attack.  It may be fatigue, chest pain, maybe a headache, maybe a jaw ache.

I would suggest you sit down with your family doc or cardiologist and discuss the tests and how you feel.  Young CAD patients can be treated very poorly by some cardiologists and it can be dismissed as anxiety or some other psychological disorder.  I would get another opinion, and I would find someone that specialized in CAD in young patients, or at least, has the brain power to review the symptoms and some testing.  I had to claw my way through some misdiagnosis.  Keep on the docs...keep questioning.  You may have to work this as a diagnosis of exclusion through testing to rule every possible in or out, such as GERD.  GERD (which I have) does not feel like angina, and it does not feel like a heart attack.

I wouldn't be alive today unless I kept pushing and pushing, 13 years after diagnosis.  Again, work with your doc, and find a specialist.  In searching for care, just because a hospital advertises themselves as being the best in heart care in the country does not mean they will solve your problem.  Don't be discouraged.  Good luck!

[ed34]

I guess it could be your anxiety but why would you get anxious towards the end of a stress test. A heart rate of 112 during exertion is nothing, I used to easily reach 186 and athletes can reach 200. Maybe you are experiencing vasospasm and this feels like angina and can be brought on by exertion or certain dietary foods. I would go back to your Doctors and not necessarily have a repeat of the tests, but maybe discuss vasospasm. In different people it feels different because the artery can be squeezed a different amount. So you have a huge range of someone having pinching pains to someone having a heart attack.I had vasospam a couple of years ago and i felt pinches in the left side of my chest. I was given medication which stopped the problem after 3 months and I have been fine since.
If not this, then it could be a vagus nerve issue. This nerve connects to everything in the body including the heart and if pinched in any way, it can give wierd results. I've had trapped gas which has irritated that nerve and given palpitations for example. So there are just 2 things to possibly think about.

[potatolover]

That would be a negative. I felt something diagonal from my chest up to my shoulder during the stress test when I was at my target heart rate but they assured me it was probably something else. It felt like a sharp pain diagonal pain from the upper left corner of my chest and went upward towards my shoulder a few inches. It went away immediately when I started to cool down.

[ed34]

I guess the obvious question to get out of the way is did you feel any of your symptoms during any of the tests or when you wore the holter monitor?